title: Endoscopic vein harvesting is influenced by patient-related risk factors and may be of specific benefit in female patients.
abstract: OBJECTIVE
  The standard of care regarding endoscopic vein harvesting (EVH) is still inhomogeneous across Europe. The current study aimed at elucidating patient-related factors favouring its application and procedure-related outcome in a tertiary care centre.
  
  
  METHODS
  All patients who underwent coronary artery bypass grafting with or without concomitant valve procedures between 2008 and 2011 were included. Emergency surgery and all arterial revascularization patients were excluded.
  
  
  RESULTS
  A total of 262 endoscopically harvested patients and 623 open vein harvested patients were included. Mortality, perfusion time and cross-clamp time were not significantly different. Peripheral artery disease predisposed open vein harvesting (odds ratio [OR] 1.9; P = 0.001); diabetes and a higher number of diseased coronary vessels favoured EVH (OR 0.6; P = 0.003 and 0.002). Further, the number of bypass grafts was significantly increased in the endoscopic group, but these patients required less periprocedural blood transfusions (1.4 ± 1.8 vs 1.8 ± 3.0; P = 0.035). Minor wound healing complications were more common in the open group (10.3 vs 3.8%; P = 0.001). Severe complications in the leg requiring surgical revision occured in 2.4% of open vein harvested patients compared with 1.1% for endoscopic patients (P = ns). After a multivariate regression analysis, only female gender remained as a significant risk factor for impaired wound healing (OR 2.4; P = 0.001), whereas EVH reduced the risk of wound-healing complications (OR 0.4; P = 0.008).
  
  
  CONCLUSIONS
  EVH dramatically reduced postoperative would healing complications. Women were more likely to develop mild and severe leg wound complications. Therefore, women may benefit even more from EVH. In general, the favourable outcomes of EVH should result in a more widespread use of this technology in men and women.
authors.affiliation: Department of Surgery, Division of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.
authors.forename: Martin
authors.initials: M
authors.lastname: Andreas
authors.forename: Dominik
authors.initials: D
authors.lastname: Wiedemann
authors.forename: Sebastian
authors.initials: S
authors.lastname: Stasek
authors.forename: Stephanie
authors.initials: S
authors.lastname: Kampf
authors.forename: Marek
authors.initials: M
authors.lastname: Ehrlich
authors.forename: Ernst
authors.initials: E
authors.lastname: Eigenbauer
authors.forename: Guenther
authors.initials: G
authors.lastname: Laufer
authors.forename: Alfred
authors.initials: A
authors.lastname: Kocher
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001317:Austria; D016009:Chi-Square Distribution; D001026:Coronary Artery Bypass; D004724:Endoscopy / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011183:Postoperative Complications / Q000209:etiology; D012307:Risk Factors; D012737:Sex Factors; D062606:Tertiary Care Centers; D020858:Tissue and Organ Harvesting / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D014680:Veins / Q000637:transplantation*; D014945:Wound Healing
keywords: Coronary artery bypass grafting; Endoscopic vein harvesting; Gender; Wound infection